Symptoms of nasal congestion associated with vasomotor rhinitis and the common cold can be relieved by the short-term use (usually not longer than 7 days) of decongestant nasal drops and sprays. These all contain sympathomimetic drugs which exert their effect by vasoconstriction of the mucosal blood vessels which in turn reduces Oedema of the nasal mucosa. They are of limited value because they can give rise to a rebound congestion (rhinitis medicamentosa) on withdrawal, due to a secondary vasodilatation with a subsequent temporary increase in nasal congestion. Ephedrine nasal (not available at health center level) drop is the safest sympathomimetic preparation and can give relief for several hours. The more potent sympathomimetic drugs Xylometazoline, and oxymetazoline are more likely to cause a rebound effect. All of these preparations may cause a hypertensive crisis if used during treatment with a monoamine oxidase inhibitor.
Mouthwashes have a mechanical cleansing action and freshen the mouth. Providone - Iodine mouthwash is useful for mucosal infections but does not inhibit plague accumulation. It should not be used for periods longer than 14 days because a significant amount of iodine is absorbed.
There is no convincing evidence that antiseptic lozenges and sprays have a beneficial action and they sometimes irritate and cause sore tongue and sore lips. Some of these preparations also contain local anesthetics which relieve pain but may cause sensitization. The throat lozenges on sale to the public at health center level are Amyl-metacresol + Dichlorbenzyl Alcohol and Dequalinium Chloride.
The most common cause of a sore throat is a viral infection which does not benefit from anti-infective treatment. Fungal mouth infections such as candida albicans which are sometimes associated with the use of broad - spectrum antibiotics or of cytotoxics; withdrawing the causative drug may lead to rapid resolution. Otherwise, an antifungal drug may be effective. Of the antifungal drugs used for mouth infections, miconazole and nystatin is not absorbed from the gastro-intestinal tract and is used by local application in the mouth. Miconazole occupies an intermediate position since it is used by local application in the mouth but is also absorbed to the extent that potential interactions need to be considered.
Amyl-Meta-cresol + Dichlorobenzyl Alcohol
Lozenges, 0.6 mg + 1.2 mg
See notes above
Dequalinium chloride
Lozenge, 0.25 ml
See notes above
Gentian Violet
Solution, 1 %
Indications: - candidal infections of the mouth and throat (thrush).
Cautions: -avoid swallowing of the solution. Infants should be turned face downward after application to minimize the amount of drug ingested.
Side effects: irritaion or sensitivity reactions, or ulceration of mucosal membranes may occur. Esophagitis, laryngitis, or trachitis may result from swallowing the solution.
Dose and Administration: Topical, to the oral mucous membranes.
It should be painted only on individual lesions with cotton.
Adults and Children: every 8 - 12 hours daily for 3 years.
Storage: - at room temperature, in tight containers.
Hexetidine*
Solution, 0.1 %
* Any mouth wash and antiseptic preparations are also acceptable
Indications: - used as a 0.1% mouthwash for local infection and/or hygiene.
Side effects: - allergic contact dermatitis and alterations in taste and smell.
Dose and Administration - use 15ml undiluted 2-3 times daily.
Menthol + Eucalyptus oil + Light Magnesium carbonate
Inhalation, 2 % + 10 % + 7 %
Indications: -for relief of nasal obstruction in acute rhinitis or sinusitis and to promote warm moist air inspiration in bronchitis.
Cautions: -boiling water should not be used for the preparation.
Dose and Administration: - add one teaspoonful to a pint of hot, not boiling, water and inhale the vapour.
Miconazole
Oral Gel, 25 mg/ml
Indications: - oral fungal infections
Cautions: - pregnancy, avoid in porphyria
Side effects: - mild gastrointestinal disturbances reported
Drug interactions: - anticoagulants, antidiabetics (sulphonylureas), phenytoin, cisapride, and cyclosporin.
Dose and Administration
Place 5 - 10 ml in the mouth after food and retain near lesions 4 times daily; child under 2 years 2.5 ml twice daily, 2 - 6 years 5 ml twice daily, over 6 years 5 ml 4 times daily
* Localized lesions smear small amounts of gel on affected area with clean finger
Storage: -at room temperature protected from light
Nystatin
Pastilles, 100,000 units
Suspension, 100,000 units/ml
Indications: - oral and perioral fungal infections
Side effects: - nausea, vomiting, and diarrhoea, oral irritation and sensitization reported
Contraindications -hypersensitivity to the drug or any ingredient in the respective formulation.
Dose and Administration: -
100,000 units 4 time daily after food. Usually for 7 days (continued for 48 hours after lesions have resolved). Nystatin 100,000 units up to four times daily may be given to neonates.
Note: Immuno suppressed patients may require higher doses (e.g 500,000 units 4 times daily). The formulation should be kept in contact with the affected area for as long as possible and patients should avoid taking food or drink earlier than one hour after a dose.
Storage: - nystatin deteriorates on exposure to heart light, moisture, or air. Nystatin oral suspension should be stored in tight, light resistant containers at room temperature; freezing of the oral suspension should be avoided.
Povidone - Iodine
Solution, 1 %
Indications: - for oral hygiene.
Cautions: - caution should be taken during pregnancy and breast feeding.
Contraindications: - avoid regular use in patients with thyroid disorders and receiving lithium therapy.
Side effects: - idiosyncratic mucosal irritation and hypersensitivity reactions, may interfere with thyroid function tests and with tests for occult blood.
Dose and Administration - Mouth wash or gargle.
Adults and children over 6 years, up to 10ml undiluted or diluted with an equal quantity of warm water for 30 seconds up to 4 times daily for 14 days.
Xylometazoline Hydrochloride
Solution (Nasal drop), 0.05 %, 0.1 %
Indications: -nasal congestion
Cautions: -avoid excessive or prolonged use, caution in infants under 3 months (no good evidence of value - if irritation occurs might narrow nasal passage)
Side effects: -local irritation, nausea, headache; after excessive use tolerance with diminished effect rebound congestion; cardiovascular effects also reported.
Dose and Administration
Adult, instil 2 - 3 drops of 0.1 % solution into each nostril 2 - 3 times daily when required; maximum duration 7 days; not recommended for children under 12 years.
Child, over 3 months instil 1 - 2 drops of 0.05 % solution into each nostril 1 - 2 times daily when required (not recommended for infants under 3 months of age, doctor's advice only under 2 years); maximum duration 7 days.
